Kicking a cigarette addiction can be difficult, especially when alternatives like e-cigarettes aren't necessarily better for you. Even though these vapes don't contain tobacco, most of them do contain some level of nicotine, according to the American Cancer Society. However, the latest research shows that many young people still assume their e-cigarettes are nicotine-free, even when they're clearly not. (Related: What Is Juul and Is It Better for You Than Smoking?)
Researchers from Stony Brook University anonymously surveyed more than 500 people between 12 and 21 years old about their smoking habits—including tobacco products, marijuana, and e-cigarettes—and compared those responses to urine samples from the participants to gauge the questionnaire's accuracy, according to a press release. Their results, which have been published in the journal Pediatrics, showed that most teens are honest about how much (and what) they smoke, but when it comes to e-cigarettes, there seems to be some confusion in terms of nicotine content. After comparing the survey responses with the urine samples, researchers found that 40 percent of those who said they use only "nicotine-free" products had significantly high cotinine (a marker for nicotine) levels in their bodies.
Knowing that all vapes have some level of nicotine in them, the urine test results aren't surprising, but the real question is, why don't users *really* know what they're inhaling?
Part of the issue might have something to do with the way these products are advertised. In fact, the FDA recently cracked down on Juul's past marketing tactics, calling for the company to take measures to lessen its appeal to teens, who might be more naive about the products they're purchasing. Juul's CEO, Kevin Burns, has since released a statement saying that the company will only sell mint, tobacco, and menthol flavors in stores, while the dessert-like flavors will only be available for online purchase.
As for nicotine content, unfortunately, not all e-cigarette brands are totally upfront about how much of the chemical is actually in their products, which is likely where the confusion stems from. While Juul gives consumers forewarning directly on its packages, and online retailers such as Mister-e Liquid, Vuse Vapor, and blu offer a disclaimer that their products contain nicotine at the top of their individual websites, these products are not closely regulated. In other words, you can't always be sure what exactly you're inhaling, Jonathan Philip Winickoff, M.D., assistant professor of pediatrics at Harvard Medical School and a specialist in family health and smoking cessation at Massachusetts General Hospital, previously told Shape. (Related: How to Quit Juul—and Why It's So Damn Hard)
"There are a huge number of knock-offs out there, and with kids trading pods all the time, you don't really know the source of your product," he explained. "It's almost like you're playing Russian Roulette with your brain."
So how much nicotine do e-cigarettes contain? The short answer: It depends. For example, data collected in a 2018 study showed that 57 percent of the e-cigarette products confiscated in schools (almost all of which were Juul products) contain more than 44 mg/mL of nicotine. (For context, the same research noted that 60 mg of nicotine may be "life-threatening.") Other e-cigarette brands, such as Mister-e Liquid, claim to give you the option to choose how much nicotine you want in your product.
But regardless of whether your e-cigarette contains a little nicotine or a heavy dose of the stuff, the negative side effects of vaping something like a Juul are not up for debate, said Dr. Winickoff. Not only do some e-cigarette liquids contain harmful carcinogens, but since the nicotine in Juul products, specifically, is engineered to taste mild, you could easily "inhale a whole package worth of nicotine without even thinking twice," he explained. From there, an addiction can develop, and the more nicotine you consume, the more serious the repercussions can become. (Related: New Study Says E-Cigarettes May Increase Your Risk of Cancer)
"[Nicotine] changes your brain to be nicotine-hungry by upping the regulation of receptors in the reward center of the brain, and there's some good evidence that nicotine addiction itself potentiates, or increases, addiction to other substances," Dr. Winickoff added. Plus, daily use of e-cigarettes can nearly double your risk of a heart attack, according to a study performed by researchers at the University of California San Francisco.
Then there are the side effects of inhaling nicotine, which can not only put your health at high risk but the health of those around you, too. Nicotine can "cause coughing and wheezing," "asthma attacks," as well as "a kind of allergic pneumonia called acute eosinophilic pneumonitis," Dr. Winickoff told Shape.
Bottom line: E-cigarettes can be just as detrimental to your health as regular cigarettes and perhaps even more addicting, so take precaution if you choose to experiment with these products.